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Outcome of Adjuvant Radiotherapy and Adjuvant Chemoradiation for Oral Cancers with Close Margins of Resection

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Oral cancers comprise 50% of all head and neck malignancies in India which can be attributed to tobacco chewing. Advanced oral cancers are managed with surgery followed by adjuvant radiotherapy or adjuvant chemoradiation. There is paucity of studies regarding need for adjuvant treatment in oral cancers with close margins i.e. ≤ 0.5 cm after formalin fixation. This study aims at documenting the oncological outcome with regards to loco-regional control, disease-free survival, overall survival and complications of adjuvant radiotherapy and adjuvant chemoradiation in operated oral cancer patients having close margins of resection. In this Retrospective cohort study, 163 patients with stage T1–T4 oral cancers operated between 2015 and 2019 who have fulfilled the inclusion and exclusion criteria, received adjuvant treatment and could be followed up for at least one year were included. At the end of 45 months, the overall survival was 74.7% and disease specific survival was 82.7%. Among the 7 patients who defaulted radiotherapy, 4 patients succumbed to the disease. Complications were bone marrow depression (2 patients), dysphagia (17) and Trismus (1). Adjuvant radiotherapy should be given in oral cancer patients with close margins of resection since it improves the oncological outcome and disease specific survival and the benefit often outweighs the risk.

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References

  1. Laprise C, Shahul HP, Madathil SA, Thekkepurakkal AS, Castonguay G, Varghese I, Shiraz S, Allison P, Schlecht NF, Rousseau MC, Franco EL, Nicolau B (2016) Periodontal diseases and risk of oral cancer in Southern India: results from the HeNCe life study. Int J Cancer 139:1512–1519. https://doi.org/10.1002/ijc.30201

    Article  CAS  PubMed  Google Scholar 

  2. Fan KH, Chen YC, Lin CY, Kang CJ, Lee LY, Huang SF et al (2017) Postoperative radiotherapy with or without concurrent chemotherapy for oral squamous cell carcinoma in patients with three or more minor risk factors: a propensity score matching analysis. Radiat Oncol 12(1):184

    Article  PubMed  PubMed Central  Google Scholar 

  3. Tasche KK, Buchakjian MR, Pagedar NA, Sperry SM (2017) Definition of “close margin” in oral cancer surgery and association of margin distance with local recurrence rate. JAMA Otolaryngol Head Neck Surg 143:1166–1172

    Article  PubMed  PubMed Central  Google Scholar 

  4. Smits RW, Koljenovic S, Hardillo JA, Ten Hove I, Meeuwis CA, Sewnaik A et al (2016) Resection margins in oral cancer surgery: room for improvement. Head Neck 38(Suppl 1):E2197–E2203

    PubMed  Google Scholar 

  5. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB et al (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944

    Article  PubMed  Google Scholar 

  6. Bernier J, Cooper J, Pajak T et al (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (22931) and RTOG (9501). Head Neck 27:843–850

    Article  PubMed  Google Scholar 

  7. Han JM, Wu GH, Zeng ZY, Chen FJ, Chen WK, Li H et al (2007) Postoperative recurrence-related factors of 125 patients with cT1-2N0 squamous cell carcinoma of the oral tongue. Ai Zheng Aizheng Chin J Cancer 26:661–665

    Google Scholar 

  8. Yanamoto S, Yamada S, Takahashi H, Kawasaki G, Ikeda H, Shiraishi T et al (2013) Predictors of locoregional recurrence in T1–2N0 tongue cancer patients. Pathol Oncol Res POR 19:795–803

    Article  CAS  PubMed  Google Scholar 

  9. Chakrabarti S, Ghosh S, Qayyumi BN, Malik A, Nair D, Nair S, Chaturvedi P, Agrawal JP (2018) Besides and beyond histopathology; for adjuvant treatment in early tongue cancer. Indian J Med Paediatr Oncol 39(03):355–362

    Article  Google Scholar 

  10. Chen WC, Lai CH, Fang CC, Yang YH, Chen PC, Lee CP, Chen MF (2016) Identification of high-risk subgroups of patients with oral cavity cancer in need of postoperative adjuvant radiotherapy or chemo-radiotherapy. Medicine 95(22):e3770

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Loree TR, Strong EW (1990) Significance of positive margins in oral cavity squamous carcinoma. Am J Surg 160(4):410–414

    Article  CAS  PubMed  Google Scholar 

  12. Weijers M, Snow GB, Bezemer DP, Van der Wal JE, Van Der Waal I (2004) The status of the deep surgical margins in tongue and floor of mouth squamous cell carcinoma and risk of local recurrence; an analysis of 68 patients. Int J Oral Maxillofac Surg 33(2):146–149

    Article  CAS  PubMed  Google Scholar 

  13. Brinkman D, Callanan D, O’Shea R, Jawad H, Feeley L, Sheahan P (2020) Impact of 3 mm margin on risk of recurrence and survival in oral cancer. Oral Oncol 1(110):104883

    Article  Google Scholar 

  14. Fridman E, Na’ara S, Agarwal J, Amit M, Bachar G, Villaret AB, Brandao J, Cernea CR, Chaturvedi P, Clark J, Ebrahimi A (2018) The role of adjuvant treatment in early-stage oral cavity squamous cell carcinoma: an international collaborative study. Cancer 124(14):2948–2955

    Article  PubMed  Google Scholar 

  15. Woolgar JA, Rogers S, West CR, Errington RD, Brown JS, Vaughan ED (1999) Survival and patterns of recurrence in 200 oral cancer patients treated by radical surgery and neck dissection. Oral Oncol 35(3):257–265

    Article  CAS  PubMed  Google Scholar 

  16. Loree TR, Strong EW (1990) Significance of positive margins in oral cavity squamous carcinoma. Am J Surg 160:410–414

    Article  CAS  PubMed  Google Scholar 

  17. Nason R, Binahmed A, Pathak K, Abdoh A, Sandor G (2009) What is the adequate margin of surgical resection in oral cancer? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:625–629

    Article  PubMed  Google Scholar 

  18. Chiou WY, Lin HY, Hsu FC, Lee MS, Ho HC, Su YC et al (2010) Buccal mucosa carcinoma: surgical margin less than 3 mm, not 5 mm, predicts locoregional recurrence. Radiat Oncol 5:79

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dik EA, Willems SM, Ipenburg NA, Adriaansens SO, Rosenberg AJ, van Es RJ (2014) Resection of early oral squamous cell carcinoma with positive or close margins: relevance of adjuvant treatment in relation to local recurrence: margins of 3 mm as safe as 5 mm. Oral Oncol 50(6):611–615

    Article  PubMed  Google Scholar 

  20. Zanoni DK, Migliacci JC, Xu B, Katabi N, Montero PH, Ganly I et al (2017) A proposal to redefine close surgical margins in squamous cell carcinoma of the oral tongue. JAMA Otolaryngol Head Neck Surg 143:555–560

    Article  PubMed  PubMed Central  Google Scholar 

  21. Eldeeb H, Macmillan C, Elwell C, Hammod A (2012) The effect of the surgical margins on the outcome of patients with head and neck squamous cell carcinoma: single institution experience. Cancer Biol Med 9(1):29–33. https://doi.org/10.3969/j.issn.2095-3941.2012.01.005

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ch’Ng S, Corbett-Burns S, Stanton N, Gao K, Shannon K, Clifford A, Gupta R, Clark JR (2013) Close margin alone does not warrant postoperative adjuvant radiotherapy in oral squamous cell carcinoma. Cancer 119(13):2427–2437

    Article  PubMed  Google Scholar 

  23. Brown JS, Blackburn TK, Woolgar JA, Lowe D, Errington RD, Vaughan ED, Rogers SN (2007) A comparison of outcomes for patients with oral squamous cell carcinoma at intermediate risk of recurrence treated by surgery alone or with post-operative radiotherapy. Oral Oncol 43(8):764–773

    Article  CAS  PubMed  Google Scholar 

  24. Fan KH, Wang HM, Kang CJ, Lee LY, Huang SF, Lin CY, Chen EY, Chen IH, Liao CT, Chang JT (2010) Treatment results of postoperative radiotherapy on squamous cell carcinoma of the oral cavity: coexistence of multiple minor risk factors results in higher recurrence rates. Int J Radiat Oncol* Biol* Phys 77(4):1024–1029

    Article  PubMed  Google Scholar 

  25. Tsan DL, Lin CY, Kang CJ, Huang SF, Fan KH, Liao CT, Chen IH, Lee LY, Wang HM, Chang JT (2012) The comparison between weekly and three-weekly cisplatin delivered concurrently with radiotherapy for patients with postoperative high-risk squamous cell carcinoma of the oral cavity. Radiat Oncol 7(1):215

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Herman MP, Dagan R, Amdur RJ, Morris CG, Werning JW, Vaysberg M, Mendenhall WM (2015) Postoperative radiotherapy for patients at high risk of recurrence of oral cavity squamous cell carcinoma. Laryngoscope 125(3):630–635

    Article  PubMed  Google Scholar 

  27. Barry CP, Ahmed F, Rogers SN, Lowe D, Bekiroglu F, Brown JS et al (2015) Influence of surgical margins on local recurrence in T1/T2 oral squamous cell carcinoma. Head Neck 37:1176–1180

    Article  PubMed  Google Scholar 

  28. Gokavarapu S, Chander R, Parvataneni N, Puthamakula S (2014) Close margins in oral cancers: implication of close margin status in recurrence and survival of pT1N0 and pT2N0 oral cancers. Int J Surg Oncol 2014:545372. https://doi.org/10.1155/2014/545372

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of ENT and Head & Neck Surgery, Sri Devaraj Urs Medical College, Kolar, India

    Lini Joseph & S. M. Azeem Mohiyuddin

  2. Department of Radiotherapy, Sri Devaraj Urs Medical College, Kolar, India

    G. N. Manjunath

  3. Department of Pathology, Sri Devaraj Urs Medical College, Kolar, India

    R. Kalyani

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  1. Lini Joseph
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  2. S. M. Azeem Mohiyuddin
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  3. G. N. Manjunath
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  4. R. Kalyani
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Contributions

LJ: Acquisition and analysis of data, Literature Search, Manuscript Preparation; SMAM: Case Identification and diagnosis, Manuscript editing, Detailed Workup, supervision; GNM: Case Identification and diagnosis, Manuscript editing, Detailed Workup, supervision; RK: Case Identification and diagnosis, Manuscript editing, Detailed Workup.

Corresponding author

Correspondence to Lini Joseph.

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Conflict of interest

The authors have no financial or proprietary interests in any material discussed in this article.

Ethical Approval

The study was approved by Institutional Ethics Committee (IEC) no. SDUMC/KLR/IEC/311.

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Informed consent was obtained from all individual participants included in the study.

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Joseph, L., Mohiyuddin, S.M.A., Manjunath, G.N. et al. Outcome of Adjuvant Radiotherapy and Adjuvant Chemoradiation for Oral Cancers with Close Margins of Resection. Indian J Otolaryngol Head Neck Surg 76, 1796–1804 (2024). https://doi.org/10.1007/s12070-023-04416-7

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  • DOI: https://doi.org/10.1007/s12070-023-04416-7

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